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Can Regional Decentralisation Shift Health Care Preferences?

Author

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  • Costa-Font, Joan

    (London School of Economics)

  • Ferrer-i-Carbonell, Ada

    (CSIC Institute for Economic Analysis)

Abstract

Uniform health care delivered by a mainstream public insurer – such as the National Health Service (NHS), seldom satisfies heterogeneous demands for care, and some unsatisfied share of the population either use private health care, or purchase private insurance (PHI). One potential mechanism to partially satisfy heterogeneous preferences for health care, and discourage the use of private health care, is regional health care decentralisation. We find robust estimates suggesting that the development of regional health services shifted both perceptions of, and preferences for, using the NHS, making it more likely individuals would use public health care and, consequently, reducing the uptake of PHI. These results are heterogeneous by income, education, and age groups; and are robust to placebo and other robustness and falsification checks.

Suggested Citation

  • Costa-Font, Joan & Ferrer-i-Carbonell, Ada, 2017. "Can Regional Decentralisation Shift Health Care Preferences?," IZA Discussion Papers 11180, Institute of Labor Economics (IZA).
    • Handle: RePEc:iza:izadps:dp11180
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    1. Propper, Carol, 1993. "Constrained choice sets in the U.K. demand for private medical insurance," Journal of Public Economics, Elsevier, vol. 51(3), pages 287-307, July.
    2. Besley, Timothy & Hall, John & Preston, Ian, 1998. "Private and public health insurance in the UK," European Economic Review, Elsevier, vol. 42(3-5), pages 491-497, May.
    3. Salmon, Pierre, 1987. "Decentralisation as an Incentive Scheme," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 3(2), pages 24-43, Summer.
    4. Besley, Timothy & Coate, Stephen, 1991. "Public Provision of Private Goods and the Redistribution of Income," American Economic Review, American Economic Association, vol. 81(4), pages 979-984, September.
    5. Besley, Timothy & Hall, John & Preston, Ian, 1999. "The demand for private health insurance: do waiting lists matter?," Journal of Public Economics, Elsevier, vol. 72(2), pages 155-181, May.
    6. Ireland, Norman J., 1990. "The mix of social and private provision of goods and services," Journal of Public Economics, Elsevier, vol. 43(2), pages 201-219, November.
    7. Iversen, Tor, 1997. "The effect of a private sector on the waiting time in a national health service," Journal of Health Economics, Elsevier, vol. 16(4), pages 381-396, August.
    8. Propper, Carol, 2000. "The demand for private health care in the UK," Journal of Health Economics, Elsevier, vol. 19(6), pages 855-876, November.
    9. Timothy Besley & Masayuki Kudamatsu, 2006. "Health and Democracy," American Economic Review, American Economic Association, vol. 96(2), pages 313-318, May.
    10. Gouveia, Miguel, 1997. "Majority Rule and the Public Provision of a Private Good," Public Choice, Springer, vol. 93(3-4), pages 221-244, December.
    11. Jeroen Klomp & Jakob De Haan, 2008. "Effects of Governance on Health: a Cross‐National Analysis of 101 Countries," Kyklos, Wiley Blackwell, vol. 61(4), pages 599-614, November.
    12. Guillem Lopez‐Casasnovas & Joan Costa‐Font & Ivan Planas, 2005. "Diversity and regional inequalities in the Spanish ‘system of health care services’," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 221-235, September.
    13. Klomp, Jeroen & de Haan, Jakob, 2009. "Is the political system really related to health?," Social Science & Medicine, Elsevier, vol. 69(1), pages 36-46, July.
    14. Mireia Jofre-Bonet, 2000. "Public health care and private insurance demand: The waiting time as a link," Health Care Management Science, Springer, vol. 3(1), pages 51-71, January.
    15. Craig Volden, 2005. "Intergovernmental Political Competition in American Federalism," American Journal of Political Science, John Wiley & Sons, vol. 49(2), pages 327-342, April.
    16. Leonard, Kenneth L., 2008. "Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect," Journal of Health Economics, Elsevier, vol. 27(2), pages 444-459, March.
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    Cited by:

    1. Judit Vall Castelló & Joan Costa-Font & Gilberto Turati & Dolores Jiménez-Rubio & Pilar García-Gómez, 2019. "Health Economics: Service Provision in Decentralised Healthcare Systems / Economía de la salud: prestación de servicios en sistemas de salud descentralizados / Economia de la salut: prestació de serve," IEB Reports ieb_report_1_2019, Institut d'Economia de Barcelona (IEB).
    2. Bertoli, Paola & Grembi, Veronica & Llaneza Hesse, Catalina & Vall Castelló, Judit, 2020. "The effect of budget cuts on C-section rates and birth outcomes: Evidence from Spain," Social Science & Medicine, Elsevier, vol. 265(C).

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    More about this item

    Keywords

    National Health Service (NHS); political decentralization; use of private health care; private health insurance; health system satisfaction; demand for private health care;
    All these keywords.

    JEL classification:

    • H7 - Public Economics - - State and Local Government; Intergovernmental Relations
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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